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Percutaneous Decompression of the Bowel with a Small-Caliber Needle: A Method to Facilitate Percutaneous Abdominal Access

Sheldon Wiebe1, Justine Cohen1, Bairbre Connolly1 and Peter Chait1

1 All authors: Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.



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  		Fig. 1. —Preliminary supine radiograph of 13-month-old boy shows air-filled colon interposed between anterior wall of stomach and anterior abdominal wall. Nasogastric tube is within stomach. Tip of forceps is at skin site of proposed site of gastrostomy tube insertion (arrow).

 


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  		Fig. 2A. —Radiographs of 13-month-old boy. Lateral view shows 27-gauge needle in air-filled colon with a drop of contrast material at needle tip (arrow). Some contrast material also is seen layering in dependent colon to confirm needle is in lumen.

 


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  		Fig. 2B. —Radiographs of 13-month-old boy. Image shows partially deflated colon with 27-gauge needle in lumen and partially inflated stomach containing nasogastric tube. Note tip of forceps is at proposed site of gastrostomy tube placement (arrow).

 


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  		Fig. 3A. —Radiographs of 13-month-old boy. Images show 18-gauge needle is in gastric lumen with a drop of contrast material at needle tip, just before placement of wire and retention suture (arrow, A). Deflated colon is displaced inferiorly beneath inflated stomach allowing safe access to anterior gastric wall (B).

 


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  		Fig. 3B. —Radiographs of 13-month-old boy. Images show 18-gauge needle is in gastric lumen with a drop of contrast material at needle tip, just before placement of wire and retention suture (arrow, A). Deflated colon is displaced inferiorly beneath inflated stomach allowing safe access to anterior gastric wall (B).

 

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